Q: I am a 21 years old male having white spots and patches on my shoulders, back, neck and above nipples for the last three-four years. These patches have started appearing on upper arms of late. What could be the cause? What medicines would you suggest for this? I masturbate very frequently (once in a day). Is this the cause of white spots? I have consulted many skin specialists but couldn't get rid of these patches. What should I do?

A:What you have is probably Pityriasis versicolor, caused by a fungus. It has nothing to do with masturbation. This is a common skin disease caused by an overgrowth of the yeast fungus called Pityrosporum orbiculare (Malassezia furfur). Everyone gets Pityrosporum orbiculare on their bodies at some point in life. This causes the person no problems unless it starts to grow excessively. Little is known of why this happens, but pityriasis versicolor is very common in subtropical and tropical regions. It is liable to flourish during the summer in this country. Profuse perspiration and high production of sebum (oil) by the skin make it easier for the fungus to multiply and spread. Pityriasis versicolor is commonly seen on the upper part of the back and on the chest, but it can be found on the entire body. The genitalia and scalp are not affected very often. People at risk include those who suffer from profuse sweating or high production of sebum, for instance teenagers and those with an immunodeficiency. However, the condition is not contagious. Many other skin diseases that require a completely different treatment can cause the same symptoms as pityriasis versicolor, so it is very important that the doctors initial diagnosis is confirmed by tests. In severe cases, the doctor may choose a treatment with itraconazole capsules. This treatment should also be followed up with preventive treatments in the subsequent year. Pityriasis versicolor can be prevented from reappearing by washing with either selenium sulphide shampoo, or ketoconazole shampoo. Talk to your doctor about this. The condition is likely to recur, so it is recommended that the preventive treatment is started in the spring. In some people, Pityrosporum orbiculare infects the hair follicles on the back and on the chest, which causes highly itchy acne-like spots to appear. This condition is called pityrosporum folliculitis, and it is more common in people who are between 30 and 40 years of age, particularly women. A treatment with itraconazole capsules will make the symptoms go away. Treatment of the first outbreak will quickly prevent the condition from developing further. However, the white patches will remain for a couple of months until the skin has renewed itself. Preventive treatment in subsequent summers can stop the white patches from reappearing.